2例儿童急性淋巴细胞白血病合并颅内静脉窦血栓形成并文献复习

Two Children with Acute Lymphoblastic Leukemia Complicated with Intracranial Venous Sinus Thrombosis and Literature Review

摘要: 目的：探讨分析急性淋巴细胞白血病患儿在诱导缓解化疗过程中并发颅内静脉窦血栓的相关危险因素及后续治疗。方法：回顾性分析南方医院2例急性淋巴细胞白血病患儿在VDLP诱导缓解化疗过程中并发颅内静脉窦血栓形成的临床表现及形成血栓的危险因素及相关治疗，并结合文献进行分析。结果：2例患儿在我院完善骨髓MICM，明确诊断为急性淋巴细胞白血病，予CCCG-ALL-2015方案开始VDLP诱导缓解化疗，诱导过程1例出现抽搐、小便失禁、意识不清，伴有凝血功能异常。1例反复出现头痛伴非喷射性呕吐，两例患儿进行头颅MRI支持颅内静脉窦血栓形成，给予抗凝治疗后病情好转，顺利进行后续巩固治疗。讨论：随着化疗方案不断优化，儿童ALL缓解率已可达90%以上，总体生存率已达80%以上。特别是近年来左旋门冬旋胺酶和培门冬酶的应用，进一步提高了急性淋巴细胞白血病化疗过程中的缓解率及无病生存率，但关注化疗带来益处的同时也应密切关注并发症的发生。其中血栓栓塞性疾病并未得到相应的关注。在小儿恶性肿瘤中，ALL是最易发生血栓的恶性肿瘤，不仅是急性淋巴细胞白血病疾病本身，特别是在VDLP诱导过程中泼尼松联合门冬酰胺酶诱导过程中最易发生。患儿在化疗过程中出现头痛、抽搐、呕吐等应及时完善头颅CT、头颅MRI。可及时发现病情，及早诊断，及时有效治疗可减少相关后遗症的发生。

Abstract: Objective: To investigate the risk factors and subsequent treatment of intracranial venous sinus thrombosis (CVT) in children with acute lymphoblastic leukemia (ALL) during induction remission chemotherapy. Methods: The clinical manifestations, risk factors and related treatments of intra-cranial venous sinus thrombosis during VDLP induced remission chemotherapy in 2 children with acute lymphoblastic leukemia in Nanfang Hospital were analyzed retrospectively, and the literature was combined for analysis. Results: The bone marrow MICM of 2 children was improved in our hos-pital and was clearly diagnosed as acute lymphoblastic leukemia. VDLP induced remission chemo-therapy was started with THE CCCG-ALL-2015 regimen. During the induction process, 1 child had convulsions, urinary incontinence, confusion, and abnormal coagulation function. One case had re-current headache with non-ejection vomiting, and two cases underwent cranial MRI to support in-tracranial venous sinus thrombosis. After anticoagulant treatment, the condition was improved, and subsequent consolidation treatment was carried out successfully. Discussion: With the contin-uous optimization of chemotherapy regimens, the remission rate of ALL in children has reached more than 90%, and the overall survival rate has reached more than 80%. Especially in recent years, the application of l-aspartase and peraspartase has further improved the remission rate and disease-free survival rate in the course of chemotherapy for acute lymphoblastic leukemia. However, it is necessary to pay close attention to the occurrence of complications while paying attention to the benefits of chemotherapy. Thromboembolic diseases have not received corresponding attention. Among malignant tumors in children, ALL is the most prone to thrombosis, not only in acute lym-phoblastic leukemia itself, but especially in the induction of prednisone combined with asparagi-nase during VDLP. In the course of chemotherapy, headache, convulsion, vomiting and other symp-toms, cranial CT and cranial MRI should be timely perfected. Timely detection of disease, early di-agnosis, timely and effective treatment can reduce the occurrence of related sequelae.